title: Physician-targeted financial incentives and primary care physicians' self-reported ability to provide high-quality primary care.
abstract: OBJECTIVE
  High-quality primary care is envisaged as the centerpiece of the emerging health care delivery system under the Affordable Care Act. Reengineering the US health care system into a primary care-driven model will require widespread, rapid changes in the management and organization of primary care physicians (PCPs). Financial incentives to influence physician behavior have been attempted with various approaches, without empirical evidence of their effectiveness in improving care quality. This study examines the above research question adjusting for the patient-centeredness of the practice climate, a major contextual factor affecting PCPs' ability to provide high-quality care.
  
  
  METHODS
  Secondary data on a sample of salaried PCPs (n = 1733) from the nation-wide Community Tracking Study Physician Survey 2004-2005 were subject to generalized multinomial logit modeling to examine associations between financial incentives and PCPs' self-reported ability to provide quality care.
  
  
  RESULTS
  After adjusting for patient-centered medical home (PCMH)-consistent practice environment, financial incentive aligned with care quality/care content is positively associated with PCPs' ability to provide high-quality care. An encouraging finding was that financial incentives aligned with clinic productivity/profitability do not to impede high-quality care in a PCMH practice environment.
  
  
  CONCLUSIONS
  Financial incentives targeted to care quality or content indicators may facilitate rapid transformation of the health system to a primary care-driven system. The study provides empirical evidence of the utility of practically deployable financial incentives to facilitate high-quality primary care.
authors.affiliation: Graduate School of Public Health, San Diego State University, San Diego, CA 92182, USA.
authors.forename: Jong-Deuk
authors.initials: JD
authors.lastname: Baek
authors.forename: Sudha
authors.initials: S
authors.lastname: Xirasagar
authors.forename: Carleen H
authors.initials: CH
authors.lastname: Stoskopf
authors.forename: Robert L
authors.initials: RL
authors.lastname: Seidman
mesh_terms: D001291:Attitude of Health Personnel; D005163:Factor Analysis, Statistical; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D058991:Patient Protection and Affordable Care Act / Q000191:economics*; D018802:Patient-Centered Care / Q000191:economics / Q000331:legislation & jurisprudence / Q000592:standards; D058007:Physicians, Primary Care / Q000191:economics* / Q000331:legislation & jurisprudence; D011320:Primary Health Care / Q000191:economics* / Q000331:legislation & jurisprudence / Q000592:standards; D011787:Quality of Health Care / Q000191:economics* / Q000331:legislation & jurisprudence / Q000592:standards; D012052:Reimbursement, Incentive / Q000331:legislation & jurisprudence; D012456:Salaries and Fringe Benefits; D020377:Self Efficacy
keywords: Affordable Care Act; Community Tracking Study Physician Survey; financial incentives; quality of primary care; salaried primary care physicians